[Treatment of equinus with serial casting]. / Tratamiento del equinismo con yesos progresivos.

INTRODUCTION: Equinus in children produces a pattern of unsteady gait and inefficient and inadequate positioning in the wheelchair. Treatment with a serial casting cycle maintains range of motion and facilitates the development of normal movement patterns. Its use in combination with botulinum toxin has proven benefits, but there is a lack of guidance on the optimal management protocol. OBJECTIVE: The aim of this study were to describe the characteristics of the population with equinus of diverse aetiology and to determine the effectiveness of treatment with serial casting. We also aimed to assess its use in conjunction with botulinum toxin in patients with spastic cerebral palsy. MATERIAL AND METHOD: This longitudinal retrospective study included a sample of 95 Achilles tendons of children attended in a children's rehabilitation clinic between 2012 and 2018, with ankle dorsal flexion less than 10°, treated by a cycle of serial casts with or without botulinum toxin. The variables analysed were sex, year when treatment started, age, BMI, diagnosis, previous and/or later treatment, spasticity (modified Ashworth), laterality, active and passive joint range of dorsal and plantar flexion along with R1 (Tardieu). Measurements were carried out with a mechanical inclinometer prior to the first, second and third cast, after the third cast and at 2, 8 and 14 months. The statistical analysis was performed with SPSS®. RESULTS: There was a statistically significant improvement of 10.02° between passive dorsal flexion prior to the first cast and after the third cast, which remained at 6.66° (P=.02) between the former and after 14 months. CONCLUSIONS: Serial casting is an effective method in the management of equinus of any aetiology and has a minimal complication rate.

[Os subtibiale: That odd ankle pain]. / Os subtibiale: esa rara molestia en el tobillo.

Os subtibiale is a low prevalence accessory bone of the ankle. This bone is located in the posterior colliculus of the tibial medial malleolus, both in paediatric and adult ages. It can cause pain, redness and/or swelling, which can lead to a mistaken diagnosis of avulsion fracture. Adequate anatomical knowledge is crucial. First, we present the case of a school-aged boy, seen at the outpatient clinic for a 2-month history of pain in both inner ankles after an injury. Second, we present the case of an adult patient with a 3-day history of right medial ankle pain, with no previous injury, evaluated at the Emergency Department. Accurate history-taking and physical examination are essential. The diagnosis is given by conventional radiology of both ankles, in antero-posterior and lateral load views. The initial treatment is conservative (splint or orthesis) to establish and maintain the function of the foot during loading activities. If there is no recovery after 6 months, surgical treatment can be considered.

[Myths and evidence on the use of botulinum toxin: spasticity in adults and in children with cerebral palsy]. / Mitos y evidencias en el empleo de la toxina botulinica: espasticidad del adulto y del nintilde;o con paralisis cerebral.

INTRODUCTION: Spasticity is a medical problem with a high incidence that significantly impact on the quality of life of patients and their families. AIM: To analyze and to answer different questions about the use of botulinum toxin type A (BTA) in our clinical practice. DEVELOPMENT: A group of experts in neurology develop a list of topics related with the use of BTA. Two big groups were considered: spasticity in adults and in children with cerebral palsy. A literature search at PubMed for English, French, and Spanish language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow for modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of spasticity in adults, such as methods for evaluating spasticity, infiltration techniques, doses, number of infiltration points, etc. Regarding spasticity in children with cerebral palsy, the document included questions about minimum age of infiltration, methods of analgesia, etc. CONCLUSIONS: This review is a tool for continuous training for neurologist and rehabilitation specialist and residents of both specialties, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: espasticidad del adulto y del nintilde;o con paralisis cerebral.Introduccion. La espasticidad es un problema medico frecuente que impacta de forma significativa en la calidad de vida de los pacientes y sus familias. Objetivo. Analizar y dar respuesta a diferentes cuestiones en el uso de la toxina botulinica tipo A (TBA) en nuestra practica clinica habitual. Desarrollo. Un grupo de expertos en neurologia elaboro una lista de temas relacionados con el uso de la TBA. Se consideraron dos grandes bloques: espasticidad del adulto y del nintilde;o con paralisis cerebral. Se realizo una revision de la bibliografia que incluyo los diferentes articulos publicados en espantilde;ol, ingles y frances hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que, segun el criterio del panel, podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. A continuacion, el texto final fue validado. Se incluyeron diferentes preguntas sobre diferentes aspectos de la espasticidad en adultos: evaluacion de la espasticidad, tecnicas de infiltracion, dosis, numero de puntos, etc. En cuanto a la espasticidad en los nintilde;os con paralisis cerebral, se analizaron preguntas como: edad minima de infiltracion, metodos de sedoanalgesia, etc. Conclusiones. Esta revision constituye una herramienta para neurologos, medicos rehabilitadores y residentes de ambas especialidades, dentro de diferentes ambitos especificos del manejo de la TBA.

[Rehabilitation treatment of vertigo]. / Tratamiento rehabilitador del vértigo.

Physical therapy should be used as a first treatment in the case of non central periferical vestibular vertigo whenever it is stable and provoked by non spontaneous position changes. In this paper we analyze the characteristics of physiotherapy in the treatment of vertigo and describe the different techniques available to the specialist.

[Bone lengthening in congenital malformations of the lower limbs]. / Alargamiento óseo en malformaciones congénitas de miembros inferiores.

The authors analyse 21 patients with congenital inequaliti of the lower limbs that had been included on a lengthening programme. The shortening aetiology was: global hipoplasy (8p), congenital deficiency of the fibula isolated (5p) or associated to proximal femoral focal deficiency (PFFD) (3p), congenital short femur (3p) and congenital abscense of the tibia (2p) The authors evaluate the anticipated discrepancy at the end of growth, the lengthening that was obtained and the complications that had been arised. On the femur and tibia hipoplasy the authors equalize the length of the lower limbs in the 75% of the patients, at only one time of lengthening. On the aplasya of the fibula the authors require two periods of lengthening and the achievement of complementary orthopaedic surgery. The authors conclude that the decision to initiate a limb lengthening programme must include not only the leg inequality evaluation, but also anothers factors like the associated anomalies, joint inestability, axial disturbance, foot condition, joint and muscle balance and the patient and family collaboration.